Scuba VBS Participant Sign-up

Participant Information

Participant Name

Date of Birth

We welcome children age 3 years (must be potty trained) through those finishing 4th grade. Students finishing 5th grade have the option to participate, or to register as a volunteer.

Grade during 2023-2024 school year

T-shirt size

Please list any allergies of which we should be aware:

Please list any other medical or behavioral concerns of which we should be aware:

During VBS, elementary-aged kids will be placed in mixed-age, small group "crews" that travel to activities together throughout the week. We encourage kids to get to know others during VBS! Kids may request that one "buddy" be in their rotation group. However, please note that honoring buddy requests cannot be guaranteed. Our policy is to place siblings in separate crews.

Note that preschool-aged kids during the 2023-2024 school year will be placed in crews together in an age-appropriate preschool program, and will not be placed in crews with elementary-aged participants.

Buddy Request

We will serve dinner from 5:30-6:00 p.m. each night. Dinner is open to all. To help us plan, please indicate below which day(s) you will eat dinner with us, and how many people from your household will eat.

Please mark the day(s) you plan to eat dinner with us:

We do not plan to eat dinner Sunday, June 2 Monday, June 3 Tuesday, June 4 Wednesday, June 5 Thursday, June 6

Please tell us how many people from your household plan to eat dinner:

For all eating dinner, please list any food allergies or dietary restrictions of which we should be aware:

Parent/Guardian Information

Parent/Guardian #1 Name

Address

This address will receive a confirmation email

Phone

Parent/Guardian #2 Name

Phone

Emergency Contact Information

Emergency Contact Name

Relationship to Participant

Phone

If you wish to list additional people authorized to pickup this participant, please provide their names below.

Alternate Pickup Name(s)

Permissions and Releases

Photo and Video Release: By selecting "YES" on this Photo and Video Release, you are authorizing Resurrection Lutheran Church to use photographs and video of hte registered participant in Resurrection publications per the Photo and Video Privacy Policy. A copy of the Policy is available for review upon request.

Photo Release

Yes No

Consent and Release: By selecting “YES” on this Consent and Release, you grant permission for the participant to fully engage in Vacation Bible School activities at Resurrection Lutheran Church.

Consent and Release

Yes No

Medical Release: By selecting “YES” on this Medical Release, I give permission for the supervising Resurrection Lutheran Church staff member or the available adult leader(s) to provide the necessary and immediate medical treatment of the participant. I give permission to those administering emergency treatment to do so using those measures deemed necessary. I furthermore absolve those acting on my behalf in this regard from liability as long as there is not gross negligence.

Medical Release

Yes No

SCUBA Music Pre-Order

Participants have the opportunity to pre-order VBS music to take home at the time of registration. Music is available as either a CD or via a digital streaming access card.

All preorders will be available for pickup on the first day of VBS. A limited number of CDs and access cards will be available for purchase the week of VBS. However, we encourage you to pre-order if you know you would like to have the music!

If you do not want to preorder music, please mark "No music" to complete the registration.

Music Preorder

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Scuba VBS Participant Sign-up

Description

Please Fix the Following